Vassar College Convocation
Wednesday, September 6, 2017
I am delighted to have a chance to address everyone today in this lovely chapel at the most beautiful college campus in the country as far as I am concerned!
As Professor Mask and I were preparing for today’s program, we were tossing around ideas related to transformation, and Professor Mask suggested I share something about my own personal experience with the idea of transformation or shift in worldview.
And it dawned on me that my career and life today look very different from where I was originally headed, and it had to do with a moment in time when the world shifted for me. It was a long time ago, but I still reflect back on it and the lesson from it stay with me. So maybe it is a story worth telling.
I finished graduate school, for the first time, in 1986, which was a master’s degree in the field of hospital administration; I started my career at Massachusetts General Hospital at the age of 24. I left the field 6 years later, at the age of 30, although these early career days greatly influenced my scholarly and practical interests in public health.
In order to follow the story, you will need to have a little background in hospital finance and history. Sorry about that. It will not be long. In 1986, when I started my career, hospitals were going through the first major wave of cost-cutting. Before this time, hospitals had been paid pretty much whatever they billed the federal government. And they were able to be reimbursed for most of the free gave they gave through various state-level financing pools. And costs were skyrocketing. To contain costs, the federal government overhauled federal hospital payment system, so that hospitals would be paid a flat fee based on the diagnosis a patient had, even if the costs of care were well beyond that flat payment. And the free care pools largely dried up, so hospitals had to subsidize the free care out of their operating budgets and endowments. To balance their budgets in this environment, hospitals became more cost conscious and scrutinized free care more rigorously.
One of my jobs in 1990 was directing the admitting office, and more pertinent, I directed the government programs office, which qualified people who had serious medical conditions and inadequate funds for free care.
One day, and I still remember it like it was yesterday, a woman showed up in my office, with a rare case of life-threatening melanoma, for which our hospital had the specific chemotherapy regimen and international experts to guide the care. She had long brown hair, and she was about my size and age. She told me her story, which was devastating. She was from Argentina and had come up to be with family and try to get the care she needed. She had no insurance, no savings, and subsistence-level income.
Part of my job was to advocate. I was to write up the circumstances and take the case to the Medical Director of the hospital, who then made the decision about free care. I had done this enough to know that her case was exceptional, and he would approve it.
I did my homework and then walked to the right office and made my case. The Medical Director considered, sighed, and then looked up from his desk. “This is not going to happen. We just cannot do it.” I was taken aback. The case to me seemed airtight. I had seen many before that were frankly less severe and they had qualified for free care, so I knew this one would. But to my shock and horror, the Medical Director carried on, saying, “She’s a foreigner; she is from Argentina. Our free care is for US citizens only.”
You will get to know me better, but I was not and am not one to take no for an answer, so I reorganized my argument and tried multiple ways to convince the Medical Director. I told him her age; we solicited a letter from the physician who said he was willing to waive his part of the fees; and we demonstrated the prognosis was almost certain death without the treatment.
But nothing would work. He repeated, “We just cannot do it. And…you will be the one to tell her.”
So I did. I told her the hospital would not accept her case. It was awful. She left, despondent. I shut my door and cried a bit, still incredulous. On that day, I knew—this job is not for me.
It was, however, a complicated conclusion, because I knew someone had to do it. The country did have limits on what it could spend. And the hospital was supported by American taxpayers, and we always spent our full free care pool. Therefore, that the free care pool was reserved for US citizens, I suppose, was not illogical.
But regardless of the logic, at root—in my gut and with my whole self—I knew I was no longer doing what I was inspired, called, and meant to do. I plotted to leave my job and have some children. And I thought it might be helpful to study for a PhD to keep my mind active while I had what I thought would be (and was) an emotionally fulfilling time with young children.
As it turned out and as I understood only later, this was a transformational moment for me.
In the following years, I threw myself into public health—eventually conducting research alongside truly inspiring people in Africa, Asia, Europe, and here in the US to improve health care delivery. In partnership with the Clinton Foundation, the Bill & Melinda Gates Foundation, and others, I discovered innovative ways of working and grew to understood health and health care more deeply than I ever imagined I would. I found myself thankful every day that I was working on issues that really mattered to me.
Transformation came by letting go of something that had meant a lot to me. The shift happened without much of a plan to start something but rather a commitment to stop something that was dragging me down and no longer inspiring me.
I experienced transformation quietly. There was no cymbal clash or lightning bolt, and no cosmic shift in the way health care would be delivered. Just my individual decision that life, for me, would change.
In your own lives at Vassar in this moment—quietly and without fanfare—you too are likely undergoing transformation. You are likely letting go of some things that have been important to you. Take a moment now to think of those: relationships with parents, siblings, friends at home; previous identities or worldviews; former habits that no longer define you.
And it may be happening, as it did for me, with some pain. Why can’t we have it all, our former lives and our future lives? And how can I leave the old when maybe there is still work to be done there?
I do not have ready answers for those questions. Except that life continues to unfold for each of us if we are open to the possibilities and have enough empty space to allow something new in, even if the old work is not yet done.
May our time together at Vassar transform each of us.
—Elizabeth H. Bradley, President, Vassar College